Compression prevents recurrent leg cellulitis

Compression therapy durably reduced recurrent leg cellulitis in adults with chronic leg swelling.
*Open-label randomized controlled trial with extended follow-up; Level 1b.

Citation

Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. eClinicalMedicine. 2026;98:104127. doi:10.1016/j.eclinm.2026.104127

Background

Recurrent leg cellulitis causes repeated illness, hospital use, and antibiotic exposure. Chronic leg swelling is a major modifiable risk factor, but swelling-focused prevention has been underused.

Patients

90 Australian adults with chronic leg swelling for at least 3 months and at least 2 cellulitis episodes in the same leg within 2 years. Exclusions included effective current compression use, contraindication to compression, end-of-life care, unstable illness, or specialist-managed chronic wounds.

Intervention

Cellulitis prevention education plus individualized fitted compression garments, worn during waking hours.

Control

Cellulitis prevention education alone; compression was later offered after early trial stopping for benefit.

Outcome

Primary: time to first recurrent cellulitis. Secondary: cellulitis-related hospital admission, leg volume, and quality of life.

Follow-up Period

Median 18 months.

Results

Outcome Compression Control Effect
Recurrent cellulitis (primary) 9/45 (20%) 21/45 (47%) HR 0.23 (95% CI 0.10 to 0.52); NNT 4
Hospitalization for recurrent cellulitis 4/45 (9%) 8/45 (18%) HR 0.25 (95% CI 0.07 to 0.90); NNT 12

HR = hazard ratio; NNT = number needed to treat.

Analyses were by intention to treat. Adherence was high: 85% wore garments at least 4 days weekly. The control was education-only, not active compression. This was not a non-inferiority trial.

Limitations

Single-center, open-label trial stopped early for benefit. Crossover limited longer randomized comparison. Cellulitis diagnosis and adherence partly relied on participant report. Findings apply best to higher-risk adults with chronic leg swelling and recurrent leg cellulitis; benefit may be smaller in lower-risk patients.

Funding

Haddenham Healthcare provided garments; funders had no data role.

Clinical Application

Offer fitted compression therapy to patients with chronic leg swelling and recurrent leg cellulitis, alongside skin care and risk-factor management.